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"Enclosed" Hemorrhage and Neonatal Jaundice

Am J Dis Child. 1961;101(2):164-169. doi:10.1001/archpedi.1961.04020030028006.
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Hyperbilirubinemia in the newborn, regardless of the cause, is a potentially dangerous state. If the serum indirect bilirubin exceeds 20 mg. %, the possibility of kernicterus is significant; the higher the bilirubin, the greater the risk of this central nervous system damage.

Many conditions and combinations of circumstances have been noted to be associated with hyperbilirubinemia in the newborn, the commonest cause being hemolytic disease of the newborn due to blood group incompatibility. Other, less common, causes include prematurity, sepsis, excessive administration of certain drugs to the mother at term or to the newborn, congenital spherocytic and nonspherocytic hemolytic anemias, and the Crigler-Najjar syndrome.

Recently, 3 newborn infants were seen with hemorrhage into their tissues, in whom significant hyperbilirubinemia developed. The hemorrhage produced an increased amount of bilirubin as the hemoglobin "enclosed" in the tissues broke down. The exposure to an excess bilirubin load, occurring at a time of life when


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